Bernard S. Pasternack

Reoperation and recurrence in Crohn's colitis and ileocolitis Crude and cumulative rates.

To determine the risks of reoperation and clinical recurrence in Crohns disease involving the colon, we analyzed by both crude and actuarial (life-table) methods follow-up data from 160 patients hospitalized with Crohns colitis or ileocolitis from 1964 through 1973. A total of 100 patients (63 per cent) underwent major operation; of these, 58 required reoperation. By the 15th year after initial operation, there was a cumulative reoperation rate of 89 and an overall clinical recurrence rate of 94 per cent. Crude data implied that the reoperation rate diminished with each succeeding operative procedure, from 58 per cent after the first operation to 47 per cent after the fourth. By contrast, actuarial analysis revealed that at the three-year follow-up point, the cumulative chance of reoperation increased from 37 per cent after the first surgical procedure to 60 per cent after the fourth. The inexorable tendency of Crohns ileocolitis to require repeated operations is demonstrable by actuarial methods.

Follow-up Study of Patients Treated by X-ray Epilation for Tinea Capitis

This is the second follow-up study of 2,215 persons who during childhood between 1940 and 1959 had been given x-ray therapy for tinea capitis and of 1,395 persons well matched for age, sex, and race who were treated for the same disease during the same period without the use of x-ray therapy. The major finding of the study was an excess incidence in the irradiated cases of tumors of the head and neck including the skin, brain, thyroid, and parotid. However, between the groups there was no difference in death due to malignant neoplasms or any other cause. Among white patients, a 40% excess of treated psychiatric disorders was observed in the irradiated group, but there was no difference among blacks.

Consumption of meat, animal products, protein, and fat and risk of breast cancer: a prospective cohort study in New York.

Epidemiologic studies have focused on the association between diet and breast cancer with conflicting results. Whereas a majority of case-control studies indicate a role for the intake of total fat and saturated fat, most prospective cohort studies either are negative or indicate very modest associations. Only a few authors have examined the role of meat intake in relation to breast cancer risk. The aim of this study was to examine the relation between risk of breast cancer and dietary intake of meat, animal products, fat, and protein. Between 1985 and 1991, we recruited 14,291 New York City women in a prospective cohort study of endogenous hormones, diet, and cancer in which they reported on their recent diet using a food frequency questionnaire self-administered at enrollment. From the cohort, 180 invasive breast cancer cases diagnosed before December 1990 and five times as many controls, individually matched by age, calendar time at enrollment, menopausal status, and, if premenopausal, phase of menstrual cycle, were included in a nested case-control study. There was an evident increase in the relative risk (RR) of breast cancer for increasing consumption of meat. Women in the upper quintile of meat consumption, as compared with the lowest quintile, had an energy-adjusted RR of 1.87 (95% confidence interval = 1.09–3.21). There was a modest RR increase in the upper quintile of total and saturated fat and no apparent association for other types of fat, protein, dairy products, poultry, or fish. The study indicates that the elevated consumption of certain foods of animal origin, such as red meat, may be a factor in explaining the postulated role of diet in breast cancer etiology.

Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients.

The medical courses of 174 young patients with aortic regurgitation were followed prospectively for a median of 10 years. The data were analyzed by life-table methods; congestive failure and angina, as well as death, were considered as end points, since the occurrence of the former is considered sufficient indication for aortic valve replacement. Thirty-one patients developed the triad of moderate or marked left ventricular enlargement, two or three electrocardiographic abnormalities, and abnormal blood pressure. Thirty-three percent of these patients either died or had failure or angina within 1 year, 48% within 2 years, 65% within 3 years, and 87% within 6 years from the acquisition of the triad. The 71 patients with none of the above features had uneventful courses. Of the 71 patients with one or two features only seven either died (three) or became symptomatic. These data are useful for patient selection for surgery before symptoms appear.

Statistical Measures of the Lower Limit of Detection of a Radioactivity Counter

AbstractThe lower limit of detection of a counter is best expressed statistically in terms of two minimal activities determined by the maximal acceptable risks of making a Type I error (of concluding there is sample activity when there is none) and a Type II error (of concluding there is no activity

Skin Cancer Incidence among Children Irradiated for Ringworm of the Scalp

A series of about 2200 children who received X-ray treatment for ringworm of the scalp (tinea capitis) during the 1940s and 1950s, and a comparable group of 1400 treated without X ray, have been followed by mail questionnaire for an average of 26 years since treatment to tabulate the incidence of skin cancer. The X-ray treatment consisted of 300-380 R to five overlapping fields on the scalp, to cause complete depilation. This delivered doses of 300-600 rad to various portions of the scalp, with lower doses to the skin of the face and neck. In the irradiated group, 41 persons have had one or more basal cell carcinomas of the scalp or face while only three have been diagnosed in controls. There was a high prevalence of multiple skin cancers in the irradiated group (80 lesions among 41 cases). The minimum latent period for radiation-induced skin cancers was long--about 20 years--and this may be attributable to the young age of the population. The skin cancer risk was particularly pronounced on the face, where there would be more UVR exposure in addition to X-ray exposure. Lightness of complexion proved to be an important factor in the skin cancer risk. In addition, skin cancers were found only among caucasians, even though 25% of the study population were blacks. These findings suggest that UVR exposure levels or sensitivity to such exposure interact with ionizing radiation exposure in defining skin cancer risk.

Skin Cancer after X-Ray Treatment for Scalp Ringworm

Abstract Shore, R. E., Moseson, M., Xue, X., Tse, Y., Harley, N. and Pasternack, B. S. Skin Cancer after X-Ray Treatment for Scalp Ringworm. Radiat. Res. 157, 410–418 (2002). Some 2,224 children given X-ray therapy for tinea capitis (ringworm of the scalp) have been followed for up to 50 years to determine cancer incidence, along with a control group of 1,380 tinea capitis patients given only topical medications. The study found a relative risk (RR) of 3.6 (95% confidence interval, 2.3–5.9) for basal cell skin cancer (BCC) of the head and neck among irradiated Caucasians (124 irradiated cases and 21 control cases), in response to a scalp dose of about 4.8 Gy. No melanomas of the head and neck have been seen, and only a few squamous cell carcinomas. About 40% of irradiated cases have had multiple BCCs, for a total of 328 BCCs. Although 25% of both the irradiated and control groups are African-American, only 3 skin cancers have been seen among them, all in the irradiated group, indicating the importance of susceptibility to UV radiation as a cofactor. Light complexion, severe sunburning and North European ancestry were predictive of BCC risk in the irradiated group, but chronic sun exposure was not. Children irradiated at young ages had the highest BCC risk. The RR for BCC risk is approximately constant with time since exposure, suggesting that risk will probably last for a lifetime.

Endogenous hormones and breast cancer: A prospective cohort study

SummaryA cohort study is under way in New York City to evaluate how levels of endogenous reproductive hormones influence the risk of breast cancer. The study, in which approximately 15,000 women are being recruited, utilizes a prospective design in which volunteers are asked to provide repeated specimens of serum during the period 1985–1992. A case-control study nested within the cohort is planned by which specimens from all cases arising in the population and from a randomly selected sample of time-matched controls will be analyzed and compared. As of December 31, 1989, 13,609 volunteers had donated blood specimens, about 50% of whom had already donated more than once. Of the 187 incident breast cancer cases who are expected to arise in the cohort before the end of 1992, 77 have been detected thus far.

Tumors and other diseases following childhood x-ray treatment for ringworm of the scalp (Tinea capitis).

Abstract— The objective of the study is to characterize the risk of tumors from radiation exposure to the head and neck. A cohort of 2,224 children given x-ray treatment and 1,380 given only topical medications for ringworm of the scalp (tinea capitis) during 1940–1959 have been followed up for a median of 39 y to determine tumor incidence. Follow-ups were by mail/telephone questionnaire, with 84–88% of the original cohort followed and with medical verification of diseases of interest. Sixteen intracranial tumors [7 brain cancers, 4 meningiomas, and 5 acoustic neuromas (vestibular schwannomas)] occurred in the x-irradiated group following an average brain dose of about 1.4 Gy, compared to 1 acoustic neuroma in the control group. The standardized incidence ratio (SIR) for brain cancer was 3.0 [95% confidence interval (CI): 1.3, 5.9]. Even though the dose to the thyroid gland was only about 60 mGy, 2 thyroid cancers were found in the irradiated group vs. none among controls, and 11 vs. 1 thyroid adenomas were found in the respective groups. Following an average dose of about 4 Gy to cranial marrow, 8 cases of leukemia (SIR = 3.2, CI: 1.5, 6.1) were observed in the irradiated group and 1 in the control group. There was also a suggestive excess of blood dyscrasias. There was no difference between the groups in the frequency of other cancers of the head and neck (excluding nonmelanoma skin cancer) or in total mortality.

A five year progress report on the effectiveness of intraluminal chemotherapy (5-fluorouracil) adjuvant to surgery for colorectal cancer

Abstract 1. 1. Nationwide survival rates after surgery for cancer of the colon and rectum have not improved in the past twenty years. 2. 2. The modes of spread of cancer of the colorectum are now well known. 3. 3. A new combined surgical, intraluminal, and systemic chemotherapy regimen has been evolved in our clinic, hopefully to inhibit tumor spread along these pathways and thus enhance survival rates. 4. 4. A five year clinical experience using 5-FU intraluminally and systemically has been computer-analyzed. 5. 5. No apparent improvement in survival rates in stage I and II cases (negative nodes) was indicated in the 5-FU treated group versus nationwide averages. 6. 6. In the positive node group (stage III) the most significant improvement seemingly develops. At five years the cumulative proportion survival rate is 65 per cent for the 5-FU treated group versus 32 per cent in the nationwide (control) series and 26 per cent in the St. Vincents Hospital (control) series. 7. 7. This is only a probing study. The authors well recognize the statistical pitfalls of such a small series of cases in a single institution. 8. 8. Hopefully a multihospital cooperative project with a double blind randomized study design may be achieved, utilizing upwards of 150 cases yearly.